Nicotine Exposure (Including Nicotine Replacement Therapy) and Wound Complications in Plastic Surgery: A...

Plastic surgery guidance recommends complete preoperative abstinence from all nicotine products. The authors evaluated whether preoperative nicotine exposure across delivery methods, including e‑cigarettes and nicotine replacement therapy, was associated with postoperative wound complications in cosmetic surgery.

In this single-institution retrospective cohort (July of 1992 through February of 2024), the authors identified adults undergoing cosmetic procedures, classifying participants on the basis of preoperative nicotine status through a single delivery method for 2 months or longer and excluding those with major confounders (eg, diabetes, peripheral vascular disease, corticosteroid use, antineoplastic therapy, body mass index greater than 30). The primary outcome was any wound complication. Logistic regression adjusted for age and procedure type.

Of 15,172 patients, 1184 (7.8%) reported nicotine use. Any complication occurred in 15.2% of nicotine users versus 3.8% of nonusers. Adjusted odds of complication were higher for nicotine users (odds ratios across delivery categories, 5.51 to 13.52). Complication profiles were similar across delivery methods; prespecified head‑to‑head comparisons among methods were not performed.

Preoperative nicotine exposure is associated with substantially higher postoperative wound complication risks in cosmetic surgery. Signals were consistent across delivery methods, supporting perioperative counseling that emphasizes complete nicotine abstinence in elective aesthetic procedures.